It’s a few minutes after 4 am, and since I couldn’t get back to sleep, I thought I’d share some thoughts that have been rattling around in my head about health, healthcare, and healthcare financing.

These three – health, healthcare, and healthcare financing – are often lumped together and just called “healthcare.” But really, they’re very different things. You will be healthier and richer if you can break them apart in your mind.

For example, maintaining your health, no matter how you look at it, is possibly the best return-on-effort you’ll find anywhere: You’ll experience a much better quality of life, you’ll be able to work for more years, and you’ll have lower medical costs along the way.

Healthcare is the service you buy from a provider to prevent or cure disease.

Healthcare financing is how you pay for it: Through insurance, with cash, or perhaps through a healthcare sharing ministry.

Miner Medical History

We are extraordinarily blessed in our family to have experienced generally good health. In addition to that, we’ve had good access to healthcare when we needed it. And we have always either been able to pay for the care we need, or it has been paid by insurance.

But this road has gotten bumpier for us from 2014 to present. This story has had a pretty big impact on our family's life and money.

From my early full-time career (2002) through my departure from John Deere (2013), we always had modestly priced premiums with significant employer subsidies for our growing family.

In 2013 I joined a much smaller company. I am proud that we offer solid health insurance to our employees and their families, but our insurance offer looks like this: My employer pays the premium of the employee, and the employee pays full-boat for the premium costs for their family. In 2013 that monthly premium for the Miners would have been $900.

2013 was the last year non-ACA compliant plans were available to me. I bought one through a broker, and for $250 per month had catastrophic coverage and access to a Health Savings Account (HSA). I thought this was pretty fair. We used very little medical care, but would not lose all our assets if something big and unexpected happened to us.

In 2014 that plan went away, crushed beneath the tumbrils of Obamacare. That same year, my employer’s offering reduced benefits and saw its premium increase to about $1000 per month. My broker found me an ACA compliant “Bronze” plan, the cheapest available, for $750 per month. My deductibles actually went up from my 2013 plan despite a tripling of my premium. Though there’s little difference between an after-tax $750 per month and a pre-tax $1000, my broker’s plan included the HSA, so we went that route.

In 2015 my broker’s plan finally cost more ($1200 per month) than my employer’s (now $1150 per month). Given the pre-tax premium payments and access to a Flexible Spending Account, we went back on the employer plan.

But [insert suitable interjection; I’ll choose “wowza”]!!! From 2013 to 2015 my gross premium grew from $250 to $1150 per month, yet the Miner family was not consuming more care. Every time I thought about how this had gone for us, my jaw went through the floor, and I either got angry, or began weeping uncontrollably.

Although healthcare and insurance costs are bad and getting worse, playground equipment has steadily improved in the last 120 years.

For readers whose employers have absorbed increases on their behalf: Be aware of the scale of the benefit you are receiving. Our family, though blessed with health, has been severely exposed to the true price of premium increases. It has been painful. For most people including us, $900 per month increase in price of something as basic as health insurance is significant. Cut you like a knife!

Finally in 2016 something began to go the right way. My employer implemented a plan with a Health Savings Account, so out of the chute I was pleased with this option. Then, I noticed a pricing anomaly in the offered plans.

The price of the plan for our entire family was still about $1150 per month. But there was an offer for “employee and children” for $160 each month. Whoa. Was this for real?

After conferring with HR, my CEO, and the benefits broker, I confirmed this was for real.

Since I am a big believer in The Principal of Constant Optimization, I immediately looked to see if there was a way to cover my wife outside the company plan in order to take advantage of the Employee and Children offer. I called my broker, and for about $300 per month we bought her a solo, ACA-compliant plan. For the first time ever, my premium expense had gone down, from $1150 per month to $460 per month. We began buying chicken again, once per week, in lieu of peanut butter souffle. The children were overjoyed.

That almost brings me current, but the ACA was not done tweaking us yet. Open enrollment for employer-based plans is in October, with new plans in effect November 1 of each year. Obamacare plan enrollment is in December, with new coverage starting January 1. Therefore, when you sign up for your employer-based plan, you don’t yet know what will be available on the “market.”

Charity’s $300 plan was cancelled of course.

My broker found a new plan for about $450 per month. We would still have been better off than under my employer’s plan, but we were ready to try something new. We signed Charity up for Samaritan Healthcare Ministries and have been participating as members there for four months now. Charity’s “Share” plus “Save-to-share” comes to a little less than $230 each month.

Sometime I may write about our experiences with Samaritan Healthcare Ministries, but at this point I don’t have anything to say: We’ve never had a shareable need. Each month we send our “share” to someone who needs it and that’s it. The teensy-bit of healthcare that Charity consumes we just pay for in hundred dollar bills. I found this blog pretty helpful in learning about Samaritan Healthcare Ministries.

I began the article promising health hacks, and have mainly delivered a story, but here’s the gold for you.

First, understand your benefits and be alert for ways to optimize. This could involve changing things up, not taking certain benefits, participating in an HSA or FSA, and choosing which family members to cover where.

Second, if you make a change like I did, be prepared to scramble to make it all work for your family. We essentially ended up having to make two health insurance decisions in less than two months.

Third, when you’re buying healthcare products or services, be smart and be a savvy negotiator. When we buy services for Charity, we start by telling the provider that we don’t have insurance, but we are prepared to pre-pay in cash. We ask for their best, cash-on-the-barrel price and we lay our money on the counter.

Fourth, when buying services that aren’t pre-negotiated (dental and vision can be in this category), try to bundle and save! I always tell our dentist I want to buy five six-month checkups at once. I tell her we’ll pre-pay by cash or check (she saves the merchant fee for the credit card processing) and ask for her best price. Buying this way usually saves 5% to 10%.

Fifth, when you get a bill, if it’s substantial (I’m not talking about a $16 lab fee), call and ask them for the least they’ll accept if you pay right now. Healthcare providers, especially hospitals, have notoriously high debt write-downs and write-offs. They’ll give you a discount and take your money.

Sixth, if you can do so without harming your health, don’t consume care and services. I’ll tell you what a heartless daddy I am. One of my children had an ear infection and received an antibiotic prescription to treat it, along with a prescription for a pain-relieving ear drop. At the cash register in the pharmacy, the pharmacists told me the antibiotic was $14, but the ear drop was $120. And I was like, “Back away, not today, Disco Lady.” We bought some children’s ibuprofen.